AMA eVoice Weekly Newsletter

Bending the spending curve

By now you've probably heard about the meeting that took place last month between President Barack Obama, the AMA and other major health care stakeholders at the White House. We met to discuss a growing issue that's straining individual, business and government budgets, and creating a system that can no longer be sustained.

I'm talking about the rising costs of health care and the effect they've had and will continue to have on our nation. The annual growth in national health expenditures—both public and private spending—is projected to average 6.2 percent through the next decade. At that rate, the percent of gross domestic product spent on health care would increase from 17.6 percent this year to 20.3 percent in 2018—higher than any other country in the world.

State and federal government programs in particular have responded to this by relying on across-the-board payment cuts to physicians and other providers. We're working to identify an alternative path. The AMA believes the far better approach is empowering physicians to implement strategies to improve quality of care and avoid inappropriate or redundant services that don't contribute to improved patient care. And our focus ison patient care—on doing the right thing for each patient, according to their needs and the best scientific evidence.

That's why the AMA, along with the Advanced Medical Technology Association, America's Health Insurance Plans, the American Hospital Association, the Pharmaceutical Research and Manufacturers of America, and the Service Employees International Union, sat down with President Obama. During this meeting, we announced our intentions to help the administration achieve its goal of decreasing the annual health care spending growth rate by 1.5 percent and saving the system an estimated $2 trillion over the next decade. AMA President-elect J. James Rohack, MD, and Chair-elect Rebecca Patchin, MD, represented the AMA during this meeting at the White House, and afterward, Dr. Rohack elaborated on it on Fox Business Network and in a guest column on KevinMD.com.

In a May 11 letter to President Obama, the AMA and partnering organizations outlined how best to achieve and sustain such a system. By improving the population's health; enhancing quality; encouraging the advancement of medical treatments, approaches and science; streamlining administration; and encouraging efficient care delivery based on evidence and best practices, we believe reduced cost growth is possible. To answer many of the inquiries about this agreement, the AMA created a question-and-answer document about slowing the rate of growth in health care costs.

And in a progress report to President Obama earlier this week, the group outlined specific initiatives each sector is undertaking to help meet this pledge. Each strategy is aimed at reducing costs, strengthening quality and improving access to care through four key areas—utilization of care, cost of doing business, administrative simplification and chronic care.

The AMA has been committed to action to achieve greater value for our health care spending for years. Through the AMA-convened Physician Consortium for Performance Improvement® (PCPI), and with the efforts of more than 100 state and national medical specialty societies, the American Board of Medical Specialties and its member boards, and 13 professional health care organizations and others, the PCPI has created and continues to develop clinical measures to promote appropriate high-quality care. Assuring that patients get the right care at the right time will improve management of chronic conditions and avoid costly hospitalizations and other interventions. This year, the PCPI is increasing its efforts to address concerns about over-utilization of services.

In addition, the AMA has launched an initiative to improve medication management to avoid adverse drug interactions for patients receiving prescriptions from multiple physicians. The AMA is intensifying its efforts in this area, and physicians can get continuing medical education credit for reading our medication reconciliation guide and implementing its strategies.

And we've advocated for proven medical liability reforms at the federal and state levels, including new and innovative medical liability reform proposals to address the practice of defensive medicine. A 2003 report from the Department of Health and Human Services revealed that defensive measures are estimated to cost the health care system anywhere from $70 billion to $126 billion per year. These situations are common, costly and adversely affect patients. Patients need a better understanding of risks and benefits. We need medical liability reforms that help physicians provide the best care without needing to order additional services to guard against possible lawsuits.

The need for health system reform is clear. The AMA is committed and ready to help bend the spending curve and move reform forward. And our initiatives are a clear demonstration of that commitment.

But we can all do our part. The combination of large-scale national initiatives and efforts by individuals to engage in prevention and wellness efforts is key to reducing spiraling health costs, preventing chronic disease and keeping America healthy.

Join us as we continue our efforts with President Obama, Congress and other key stakeholders to make reform a reality.

1) AMA outlines initiatives to White House to help slow increases in health spending
The AMA joined with five other organizations in the health sector earlier this week to outline initiatives that can help achieve President Barack Obama's goal of decreasing the health care cost growth rate by 1.5 percent, saving $2 trillion or more over the next 10 years.

"The AMA is committed to action to help achieve greater value from our nation's health-care spending," AMA President Nancy H. Nielsen, MD, PhD, said. "We want to help bend the spending curve and move forward on health reform. Our proposals focus on making sure people get the right care at the right time, addressing appropriateness of care, overutilization of some services and avoidable hospital readmissions."

Visit the AMA Web site to read more from Dr. Nielsen and to view a letter to Obama from the AMA and other organizations.

For more about this topic, read Dr. Nielsen's column on the right-hand side of this newsletter.

2) Online resource can help you hold health insurers accountable
Have you filed a complaint about a health insurer through its internal complaint submission process but haven't seen any results? Then check out the AMA's "Timely and accurate payment toolkit" and learn about the various other complaint mechanisms available to you, including your state's insurance department and the health insurer settlement compliance dispute process. File a complaint—and hold health insurers accountable to fair business practices.

Learn more about the health insurer settlement compliance dispute process.

3) AMA journal study analyzes new method to evaluate disaster readiness of U.S. cities
An innovative computer-based modeling approach for rare public health emergencies can help with disaster planning and medical response efforts in metropolitan areas, according to findings published this week by the AMA's Disaster Medicine and Public Health Preparedness journal.

View a news release about the study.

4) Joint Commission seeking comments about National Patient Safety Goals, Universal Protocol
All physicians are invited to provide their feedback about the Joint Commission's National Patient Safety Goals (NPSG) and Universal Protocol as part of a field review. The Joint Commission is revising this year's NPSGs and Universal Protocol to clarify language and make sure both are relevant to the settings in which they apply. Comments are due by June 23.

Visit the Joint Commission Web site to learn more and to access field review documents.

5) CME credit for reading JAMA and Archives articles: just one benefit of AMA membership
Are you fulfilling all of your continuing medical education (CME) credit requirements? And do you have convenient avenues lined up to do so? AMA members have an easy method that is right at their fingertips: the Journal of the American Medical Association (JAMA) and Archives journals.

After reading articles in JAMA and the Archives journals, AMA members can take a brief online quiz, complete an evaluation and claim AMA PRA Category 1 Credit™. There are 48 credits available annually through JAMA, 22 through the Archives of Internal Medicine and 12 through each of the other five Archives journals. Choose your method: Read in print or online and claim your credit using My CME.

Learn more about earning AMA PRA Category 1 Credit™ through JAMA and the Archives journals.

If you're an AMA member, don't lose valuable resources such as the opportunity to earn AMA PRA Category 1 Credit™ for journal CME. Visit the AMA Web site to renew your membership. If you're not a member, visit to join the AMA today and begin receiving them.

Accreditation statement
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

6) In JAMA: Childhood health disparities can have life-long health effects
Research indicates that physical and mental stress in childhood may have life-long adverse health effects. With that, policy initiatives are needed to emphasize the importance of starting health promotion and disease prevention early in life, according to an article in the June 3 issue of the Journal of the American Medical Association (JAMA), a theme issue on child and adolescent health.

View the theme issue on child and adolescent health.

1) In the Advocate: California school district adopts GLBT anti-bullying curriculum
According to the Advocate, the Alameda Unified School District board in Alameda, Calif., recently adopted a new anti-bullying curriculum for elementary school students aimed at teaching respect for gay, lesbian, bisexual and transgender (GLBT) families and peers. The curriculum, which passed by a 3-2 vote May 26, will add lessons and introduce discussions about gay, lesbian and bisexual families and sexual orientation stereotypes starting in the fourth grade.

2) California Supreme Court upholds Proposition 8
In a 6-1 ruling last week, the California Supreme Court upheld Proposition 8's ban on same-sex marriage but also ruled that gay couples who wed before the measure was approved by voters last fall will remain married under state law. Proposition 8 passed with 52 percent of the vote in November.

View a story about the ruling published by the Los Angeles Times.

3) AMA resources can help patients understand the nuances of Medicare Advantage
Two new resources can help AMA member physicians educate their patients and staff about the benefits and problems associated with participation in Medicare Advantage plans.

One resource, "Attention Medicare beneficiaries: What you need to know about Medicare Advantage," provides basic information about the program, including what to expect in terms of benefits, enrollment and health insurer marketing of these plans. The other resource, "Attention Medicare beneficiaries: Which plan is right for you," provides a brief overview of the different types of Medicare Advantage plans.

AMA members can visit the AMA Web site to view and download these resources.

1) AMA-IMG Governing Council election results are in
AMA-IMG Section members elected Nyapati Rao, MD; Sarala Rao, MD; Raouf Seifeldin, MD; and Jayesh Shah, MD, to the section's governing council. The four new governing council members will begin three-year terms June 18. The section congratulates the winners and thanks all who participated in the election.

2) Register to attend the AMA-IMG Section meeting
Mark your calendars for the AMA-IMG Section Assembly meeting, which will take place June 12–15 at the Hyatt Regency Chicago. Scheduled events include:

• The AMA-IMG Section Congress on June 12, with a keynote address by James Hallock, MD, president of the Educational Commission for Foreign Medical Graduates (ECFMG), who will speak about the state of the ECFMG.
• The AMA-IMG Section candidates forum and caucus June 13
• The fourth annual Desserts From Around the World and IMG Honor Fund Reception on June 13
• The AMA-IMG caucus June 15.
• The Busharat Ahmad, MD, Leadership Program, featuring Dr. Hallock, on June 15.

Visit the AMA-IMG Web site for the assembly meeting's full schedule and to register to attend.

Learn more about the Desserts From Around the World and IMG Honor Fund Reception. Send an e-mail to make a donation to the IMG Honor Fund.

Contact J. Mori Johnson at (312) 464-5678 or send an e-mail if you have questions or if you wish to give an organizational report during the AMA-IMG Section Congress.

Brought to you by the AMA Section on Medical Schools

1) Annual Meeting agenda book to be online next week
The agenda book for the upcoming AMA-SMS meeting will be available to download from the section's Web page early next week. Meeting registrants who requested paper copies or CDs of the agenda book will receive them this week.

View the AMA-SMS Web site.

Send an e-mail to Jackie Drake or call (312) 464-4389 if you have questions.

2) In American Medical News: Bad behavior by physicians can't be ignored
A recent "ethics forum" in American Medical News presented a scenario on how to help a disruptive physician colleague. The forum, a regular feature in American Medical News, notes that it's the ethical obligation of colleagues to intervene in situations like this because such behavior affects patient care through its influence on the medical team's effectiveness.

3) 2008 AMA Annual Report available
The 2008 AMA Annual Report is now available on the AMA Web site. Included in the report is a summary of the organization's financial performance. The report also highlights a few of the countless examples of the AMA's response to the needs of America's physicians that supports their ability to do what they do best: help patients.

4) In Virtual Mentor: Specialty choice and business decisions in medicine
The May issue of Virtual Mentor, the AMA's online ethics journal, explores the ethical dimensions of physician specialty choice and the intersection of the profession and business of medicine.

1) Enter Virtual Mentor's student essay contest
All medical students are invited to take part in the John Conley Foundation for Ethics and Philosophy in Medicine ethics essay competition. The competition is presented by Virtual Mentor, the AMA's online ethics journal.

This year's competition examines the topic of physicians' conscientious objection to discussing or providing treatment options to patients that are legal but objectionable to a physician's religious beliefs.

View the scenario, essay guidelines and instructions for how to enter the contest. The author of the best essay will be awarded $5,000, and the winning essay will be published in Virtual Mentor.

Submissions must be sent as e-mail attachments to Faith Lagay by July 31.

Visit the Virtual Mentor Web site to learn more about the contest.

2) Take part in national service project event during AMA-MSS meeting
The AMA-MSS will hold a national service project event June 12 in conjunction with this year's AMA-MSS Assembly meeting. Continuing with the theme of "Covering the uninsured and protecting access to care," AMA-MSS members will distribute information about the importance of access to care, health system reform and the availability of safety net health coverage and services in the Chicago area through Medicaid, Illinois' All Kids program, and various free clinics and subsidized providers in the city.

Students interested in participating in this event must reserve a spot by June 8. Visit the AMA-MSS Web site or send an e-mail with your name, school and phone number to do so.

3) Submit AMA-MSS Reference Committee testimony online
AMA-MSS members are encouraged to submit reference committee testimony for the section's annual assembly meeting online in advance of the traditional reference committee hearing at the meeting. All testimony submitted online will be considered along with testimony heard in person as the AMA-MSS Reference Committee makes its recommendations to the assembly.

Send an e-mail with questions.

4) Make hotel reservations for the AMA-MSS meeting
The AMA has reserved blocks of rooms at a discounted rate at the Hyatt Regency Chicago and at the nearby Courtyard Marriott for attendees of the AMA-MSS Assembly meeting. Rooms are limited and sure to go fast, so make your reservation today.

If you're looking for someone to share the cost of a hotel room, access the AMA-MSS A-09 Housing Exchange Forum and communicate with other meeting attendees.

5) Learn about the brachial plexus in five minutes
Do you know and understand the brachial plexus? Would you like to in just a few moments? You can by accessing the special resource "Learn the Brachial Plexus in Five Minutes or Less," which contains a simple method that can help you familiarize yourself with this arrangement of nerve fibers quickly and easily.

6) Chapter of the Week: Loma Linda University medical students create pathway to health
In an effort to stress the importance of walking and exercise, medical students at Loma Linda University helped create a walkway at the school's student clinic June 1 during the school's annual Healthy Neighborhoods Health Fair. Patients are encouraged to use the quarter-mile path while waiting for appointments, and clinic employees received a pedometer to track their own steps when using the walkway. Every time an employee finishes 5 miles, their name will be entered into a drawing for a prize.

Send an e-mail to Karen Studer, a medical student at Loma Linda University, for more information about this project.

What is your chapter doing for your community? The AMA-MSS has a number of resources to help you plan a great event, including chapter involvement grants (CIG). Chapters are eligible for $1,000 per academic year with a maximum of $250 to $500 per event.

Apply for a CIG at least 30 days before your event.

Send an e-mail to find out how much grant money your chapter has left this academic year ending June 30.

Brought to you by the AMA Minority Affairs Consortium

1) AMA-MAC caucus set for June 12
Plan to attend the AMA-MAC caucus, which will take place from 4 to 6 p.m. June 12 at the Hyatt Regency Chicago preceding the Annual Meeting of the AMA House of Delegates. Hector Castro, MD, medical director of the Latino Health Institute of New York, will speak about the institute's mission to improve the health status of New York City's Hispanic community by overcoming cultural, language and economic barriers to quality health care.

Send an e-mail to reserve a seat at the caucus.

1) Leadership program about meeting management offered before Annual Meeting
Plan to attend "Parliamentary procedure 101," an educational program to be held from 5:45 to 6:45 p.m. June 11 preceding the Annual Meeting of the AMA House of Delegates (HOD).

Presented by Jeremy A. Lazarus, MD, and Andrew W. Gurman, MD, speaker and vice speaker of the AMA-HOD, respectively, the program will review the basic parliamentary procedures, including the usual motions and how they are utilized, in the AMA-HOD. Departures from usual parliamentary procedures will be discussed, as well as how AMA-HOD business is processed.

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The American Medical Association designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

2) AMA-OMSS meeting handbook now available
The AMA-OMSS Assembly meeting handbook and supplement are available online. A hard copy and/or CD of the handbook will be available at the meeting, which will be held June 11–13 at the Hyatt Regency Chicago.

The deadline to register for the meeting is June 5, and late resolutions are due to the AMA-OMSS by 4 p.m. CST June 11.

Send an e-mail to James DeNuccio with late resolutions.

Learn more about the AMA-OMSS Assembly meeting.

Visit the AMA-OMSS Web site to register for the meeting and make travel arrangements.

3) AMA partners with AAPPO on new contracting toolkit
To help physicians, preferred provider networks and payers develop a common understanding during contracting discussions, the American Association of Preferred Provider Organizations (AAPPO) and the AMA have partnered to develop a contracting toolkit for physicians. This educational guide is designed to create a common ground for discussions between physicians, preferred provider networks and payers by fostering a better understanding of contractual agreements and diminish the potential for problems or misunderstandings that arise after a contract is executed.

4) Interim Meeting webcasts added to archives
The AMA-OMSS has posted a pair of 90-minute educational webcasts to its Web pages: "Physicians as Targets and How to Avoid Being One" and "Organized Medical Staffs and Disruptive Behavior." Both of these programs provide AMA PRA Category 1 Credit™.

Accreditation statement
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation statement
The American Medical Association designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

1) AMA-RFS meeting fast approaching
Join the AMA-RFS for its annual assembly meeting June 11–13 at the Hyatt Regency Chicago. The meeting is an excellent opportunity to network with colleagues from across the country, participate in policy-making sessions and attend informative educational sessions.

Visit the AMA-RFS Web site learn more about the meeting and to download the meeting handbook, which includes reports and resolutions to be considered at the meeting.

2) Leadership program about meeting management offered before Annual Meeting
Plan to attend "Parliamentary procedure 101," an educational program to be held from 5:45 to 6:45 p.m. June 11 preceding the Annual Meeting of the AMA House of Delegates (HOD).

Presented by Jeremy A. Lazarus, MD, and Andrew W. Gurman, MD, speaker and vice speaker of the AMA-HOD, respectively, the program will review the basic parliamentary procedures, including the usual motions and how they are utilized, in the AMA-HOD. Departures from usual parliamentary procedures will be discussed, as well as how the business of the AMA-HOD is processed.

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The American Medical Association designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

3) Apply for a seat on an AMA-RFS standing committee
The AMA-RFS is accepting applications for positions on its standing committees. Committee seats are appointed by the section's governing council for a one-year term. Apply for a position on the

• Committee on long-range planning
• Committee on medical education
• Membership committee
• Legislative advocacy committee
• Poster symposium committee
• Public health committee

Visit the AMA-RFS Web site to learn more about these committees and to apply for a seat on one of them.

4) AMA resources can help patients understand the nuances of Medicare Advantage
Two new resources can help AMA member physicians educate their patients and staff about the benefits and problems associated with participation in Medicare Advantage plans.

One resource, "Attention Medicare beneficiaries: What you need to know about Medicare Advantage," provides basic information about the program, including what to expect in terms of benefits, enrollment and health insurer marketing of these plans. The other resource, "Attention Medicare beneficiaries: Which plan is right for you," provides a brief overview of the different types of Medicare Advantage plans.

AMA members can visit the AMA Web site to view and download these resources.

5) Learn about electronic claims submission: just one benefit of being an AMA member
Are you starting a practice? Then it's time to get a preliminary introduction to electronic claims systems.

Visit the AMA Web site to renew your AMA membership, or join the AMA, and have access to valuable resources such as this.

1) Annual Meeting program to discuss competency, recertification and the value of experience
The AMA-SPG is jointly sponsoring a continuing medical education program titled "Keeping Senior Physicians in Practice: Issues of Competency, Recertification and the Value of Experience" from 1 to 2:30 p.m. June 13 during the Annual Meeting of the AMA House of Delegates.

John A. Fromson, MD, assistant clinical professor of psychiatry at Harvard Medical School, will help attendees understand the value that senior physicians bring to a practice, the most common age-related issues to be aware of, and practical solutions and environmental adjustments to address those issues.

The program also is sponsored by the AMA Organized Medical Staff Section and the AMA Advisory Committee on Group Practice Physicians.

Accreditation statement
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation statement
The American Medical Association designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

2) Law opens up volunteer opportunities for seniors
A new law that authorizes a dramatic funding increase for AmeriCorps and other volunteer programs, along with the creation of new programs for seniors, is scheduled to take effect Oct. 1.

The law, known as the Edward M. Kennedy Serve America Act, creates new service options for seniors by expanding age and income eligibility for the Foster Grandparents and Senior Companions programs; authorizing a Silver Scholars program, through which people 55 and older who perform 350 hours of service receive a $1,000 education award; and establishing Serve America Fellowships and Encore Fellowships, which will allow individuals to choose from among registered service sponsors where to perform service. The law also permits those 55 and older to transfer their education award to a child or grandchild.

Brought to you by the AMA Women Physicians Congress

1) AMA-WPC caucus set for June 13
Plan to attend the AMA-WPC caucus, to be held from 5:30 to 7:30 p.m. June 13 at the Hyatt Regency Chicago as part of the Annual Meeting of the AMA House of Delegates.

As part of the caucus, the 2008 recipients of the Joan F. Giambalvo Memorial Scholarship will present results of their research. Sue Yom, MD, will report on the results of her study, "Why do they leave? Female faculty retention and the costs of academic attrition," and Maurice Clifton, MD, will present preliminary findings from his study, "Defining obstacles to the practice of medicine in rural areas by women physicians."

The caucus also will include a special celebration in recognition of the 30th anniversary of the AMA's Women in Medicine Program.

2) WPC liaisons: Annual breakfast meeting to be held June 15
The AMA-WPC Liaison Breakfast will be held from 7:30 to 8:45 a.m. June 15 at the Hyatt Regency Chicago as part of the Annual Meeting of the AMA House of Delegates. Liaisons are asked to reserve a seat at the breakfast by sending an e-mail or calling (312) 464-4743.

WPC liaisons are appointed by executive directors of state and specialty medical societies. If you are unaware if one of your organizations has a liaison or would like more information about how to become a liaison, contact the AMA-WPC by e-mail or call (312) 464-4743.

1) Download the AMA-YPS meeting handbook
The AMA-YPS Assembly handbook is available to be downloaded. This year's AMA-YPS Assembly meeting will be held June 11–13 at the Hyatt Regency Chicago.

Visit the AMA-YPS Web site for more information about the meeting.

2) AMA-YPS announces community service award winners
The following physicians will receive AMA-YPS Community Service Awards on June 12 during the AMA-YPS Assembly meeting:

• Robert F. Melendez, MD, for his work with the Juliette RP Vision Foundation
• Brent R. Middlestaedt, DO, for his work with Photos for the Forgotten
• Michael S. Provenghi, MD, for his work with the Mobile Clinic Program

Through its annual Community Service Award, the AMA-YPS strives to not only recognize excellence in community service activities carried out by young physicians but to encourage similar efforts by other doctors. Congratulations to this year's winners.

3) Leadership program about meeting management offered before Annual Meeting
Plan to attend "Parliamentary procedure 101," an educational program to be held from 5:45 to 6:45 p.m. June 11 preceding the Annual Meeting of the AMA House of Delegates (HOD).

Presented by Jeremy A. Lazarus, MD, and Andrew W. Gurman, MD, speaker and vice speaker of the AMA-HOD, respectively, the program will review the basic parliamentary procedures, including the usual motions and how they are utilized, in the AMA-HOD. Departures from usual parliamentary procedures will be discussed, as well as how the business of the AMA-HOD is processed.

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The American Medical Association designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

4) AMA resources can help patients understand the nuances of Medicare Advantage
Two new resources can help AMA member physicians educate their patients and staff about the benefits and problems associated with participation in Medicare Advantage plans.

One resource, "Attention Medicare beneficiaries: What you need to know about Medicare Advantage," provides basic information about the program, including what to expect in terms of benefits, enrollment and health insurer marketing of these plans. The other resource, "Attention Medicare beneficiaries: Which plan is right for you," provides a brief overview of the different types of Medicare Advantage plans.

AMA members can visit the AMA Web site view and download these resources.